Back-To-Care

Loss to follow-up is a major issue for ART clinics, and Lighthouse addresses this challenge through program innovations. At Lighthouse, our Back-To-Care (B2C) project was designed to improve long-term retention in ART treatment through active follow-up of patients. The B2C project was introduced at both Lighthouse and MPC in July 2006 and September 2007, respectively. B2C aims to improve long-term patient retention in ART treatment by using the electronic data system (EDS) to routinely identify patients who missed ART dispensing visits by more than 21 days. The B2C project maintains three permanent staff for tracing patients: one staff member contacts lost to follow-up clients by phone and two staff members conduct home visits. We first trace the patient/guardian by phone or, if unable to reach them, we send trained field tracers to visit their homes using locator maps filled by all patients at ART initiation. Phone tracing and field tracing use standardized forms for data collection to ascertain the patients' true ART outcome status. Possible outcomes include: death; transfer to other ART facility; alive and on ART; stopped ART; tracing rejected; refused comment; and lost to follow-up. All patients found alive who have not transferred to another ART facility are asked to return to the clinic. Field tracers can schedule a specific appointment date at the clinic.

Our B2C program is one of the largest programs to actively reduce loss to follow-up of ART patient in sub-Saharan Africa. While death is the most common reason for missing scheduled visits, our program also successfully identifies those who transfer care and returns about 50% of patients alive for continuation of care. We have had much success in retaining ART clients in treatment and care, evidenced by a recent article detailing our programmatic success (http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2010.02509.x/full). Lighthouse plans to expand the B2C program to also trace those who default from pre-ART care as well as those who default from TB treatment.